CAJ | 학술논문

目的研究调节动脉化静脉皮瓣的前负荷,减少静脉皮瓣术后的组织肿胀程度,对皮瓣存活质量的影响.方法选取新西兰大白兔10只,在下腹壁两侧设计静脉皮瓣共20例,利用股动脉分支(腹壁下动脉)与一条静脉皮瓣皮下静脉吻合形成动脉化静脉皮瓣.左侧为实验组10例,不结扎股动脉远端,形成动脉压力和血流分流调节模式;右侧为对照组10例,结扎腹壁下动脉分支以远股动脉主干,形成股动脉-腹壁下动脉直接供血模式.在对照组结扎股动脉前后分别测定腹壁下动脉内血压的变化.于术后3d在皮瓣边缘取材,对静脉皮瓣组织学进行观察.结果实验组静脉皮瓣存活8例,部分存活1例,坏死1例;对照组静脉皮瓣存活5例,部分存活4例,坏死1例,两组差异有统计学意义(P＜0.05).实验组静脉皮瓣存活质量优于对照组.压力测定结果显示,不结扎股动脉与结扎股动脉两种情况下,腹壁下动脉收缩压平均降低10％.皮瓣组织学观察,实验组结果优于对照组.结论通过术式改良调节动脉化静脉皮瓣的前负荷,改善了皮瓣内血液的灌流平衡,减少了静脉皮瓣术后的组织肿胀,静脉皮瓣存活质量得到明显改善.
목적 연구조절동맥화정맥피판적전부하,감소정맥피판술후적조직종창정도,대피판존활질량적영향.방법 선취신서란대백토10지,재하복벽량측설계정맥피판공20례,이용고동맥분지(복벽하동맥)여일조정맥피판피하정맥문합형성동맥화정맥피판.좌측위실험조10례,불결찰고동맥원단,형성동맥압력화혈류분류조절모식;우측위대조조10례,결찰복벽하동맥분지이원고동맥주간,형성고동맥-복벽하동맥직접공혈모식.재대조조결찰고동맥전후분별측정복벽하동맥내혈압적변화.우술후3d재피판변연취재,대정맥피판조직학진행관찰.결과 실험조정맥피판존활8례,부분존활1례,배사1례;대조조정맥피판존활5례,부분존활4례,배사1례,량조차이유통계학의의(P＜0.05).실험조정맥피판존활질량우우대조조.압력측정결과현시,불결찰고동맥여결찰고동맥량충정황하,복벽하동맥수축압평균강저10％.피판조직학관찰,실험조결과우우대조조.결론 통과술식개량조절동맥화정맥피판적전부하,개선료피판내혈액적관류평형,감소료정맥피판술후적조직종창,정맥피판존활질량득도명현개선.
Objective To investigate the impact of regulating the preload of arterialized venous flap and reducing postoperative tissue swelling on flap survival and quality.Methods Ten New Zealand white rabbits were used to create 20 venous flaps on both sides of the abdominal wall.A branch of the femoral artery (inferior epigastric artery) was anastomosed with a subcutaneous vein in the venous flap to arterialize the venous flap.The 10 flaps on the left side were designated as venous flaps of the experimental group in which the distal end of the femoral artery was not ligated,forming a mode of regulated pressure in the artery and blood flow bypass.The 10 flaps on the right side were designated as venous flaps of the control group in which the main femoral artery distal to the branch of inferior epigastric artery was ligated,forming a femoral artery-inferior epigastric artery direct blood supply mode.Before and after ligation of the femoral artery in the control group,the changes of pressures in the inferior epigastric artery were determined.Tissue samples were collected from the edge of the flaps 3 days after the operation for histological observation.Results In the experimental group,8 venous flaps survived completely,while 1 partially survived and 1 necrotized.In the control group,5 venous flaps survived,while 4 partially survived and 1 necrotized.There was statistically significant difference in flap survival between the two groups (P ＜ 0.05).The survival quality of venous flaps in the experimental group was better than that in the control group.Measurement of inferior epigastric artery pressure showed that the systolic pressure without ligation of the femoral artery was 10％ lower than that with ligation of the femoral artery.Histology of flaps revealed better results in the experimental group.Conclusion The modification of arterialized venous flap regulates the perfusion pressure (preload) and improves the balance of blood perfusion in the flap.The occurrence of postoperative tissue swelling is reduced.The survival quality of the venous flap is greatly improved.